The role of pharmacists is quickly moving from that of a vendor to that of a health care provider. As a result, pharmacists are increasingly concerned about advising patients regarding the selection, use and side effects of over-the-counter and prescription drugs. A pharmacist typically obtains information relating to the patient's history directly from the patient, accepts orders for over-the-counter and prescription drugs; conducts an analysis in terms of a cognitive review of the drug and the patient's history, and conducts a counseling session with the patient during which the pharmacist advises the patient about substitute generic drugs, provides instructions for administering the drug, and advises the patient about possible side effects resulting from use of the drug. Thereafter, the pharmacy dispenses the prescribed drug or an equivalent generic drug.
Recently, computer based systems have been introduced to automate this process. Pharmaceutical care systems, typically controlled by a microprocessor, assist a pharmacist in analyzing the impact of drugs with respect to particular patients and to correspondingly provide advice to particular patients based on particular over-the-counter or prescription drugs and specific patient histories. The computer based systems may include a processing unit, a keyboard, a display screen and a printer. These systems assist in the collecting (i.e., intake) of patient history information, conducting of a cognitive analysis, counseling of patients, and dispensing over-the-counter and prescription drugs.
One example of a computer based system used by pharmacists is the PharmCare.TM. system marketed by Pharmaceutical Care Services, Inc. of Waco, Texas. PharmCare.TM. provides a sequential workflow and is mitten in a high level computer language such as Cobol. The PharmCare.TM. system assists the user with collecting patient information, conducting of cognitive and counseling sessions, and correlating the results of the cognitive and counseling sessions. During cognitive analysis, the PharmCare.TM. system conducts an automated drug utilization review ("DUR") (also sometimes referred to as drug regimen review ("DRR") during which an interactive check is made between the over-the-counter or prescribed drug and allergies, pregnancy status, age, and other characteristics and conditions of the patient. During the cognitive phase of the PharmCare.TM. system, and in particular, during DUR, a pharmacist can create a "SOAP." "SOAP" stands for "Subjective" data, "Objective" data, "Assessment" of data, and "Plan." The subjective data generally refers to any data received that is opinion based while the objective data refers to any data received that is factual based. During the assessment phase, the pharmacist conducts an analysis of the solutions after collecting the data and running the drug review. During planning, the pharmacist determines the action to be taken based on the results of the assessment.
Specifically, the subjective data includes diagnoses, allergies, adverse drug reactions, lifestyle information, problems in general or with drugs, drugs not purchased at the particular pharmacy, over-the-counter drugs presently being taken by the patient, the patient's physicians, the patient's symptoms, and socio-economic considerations. The objective data is a profile of the patient's drug history, and includes data relating to interactions between drugs, interactions between drugs and diseases, interactions between drugs and food, as well as the age and weight of the patient. Additional miscellaneous data is also considered during the SOAP analysis for consistency purposes. The miscellaneous data includes refill frequency dates, nature of over-the-counter drug use, a patient's understanding of particular situations and target goals of the therapy, and a pharmacist's observation of the results of the consultation session with the patient.
During assessment, the pharmacist determines if each of the subjective and objective data are in order and if any problem exists or potential problem exists as a result of the subjective and objective data. For example, a drug incompatibility may exist or the drug prescribed for the patient may be inconsistent with the patient's lifestyle. Finally, during planning, the pharmacist identifies an action to remove any potential or existing negative results of the drug use, sets target goals, if necessary, and follows up on any previous progress notes.
The PharmCare.TM. system also provides for creation of a RAR (i.e., "Reason," "Action" and "Result"). During a RAR, the pharmacist documents the actual action taken as a result of the interaction between the pharmacist and the patient in order to justify billing the patient or third party payer for the consultation session with the patient. In general, SOAP refers to the clinical portion of the analysis and RAR refers to the billing or financial portion resulting from the analysis. The PharmCare.TM. system allows the user to associate one RAR with one SOAP.
Unfortunately, the prior art systems do not provide the flexibility necessary in order to fully transform the role of a pharmacist from a drug vendor or dispenser to a health care provider, allowing the pharmacist to recapture the value added by the pharmacist during encounters with patients. For example, the pharmacist may not be able to recapture all of the value added by the pharmacist during the encounter with the patient and subsequently bill the patient or third party payer for the total value added by the pharmacist.
In addition, it is not uncommon for the pharmacist to be interrupted while performing tasks. Prior art systems are indexed, sequential database systems which may require the system to discontinue any analysis being conducted when the interruption is received.